Eligible Expenses

ELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible AccountAA Meetings, transportation to Yes Health Care FSA, HSA

Abortion Yes Health Care FSA, HSA

Acne treatment Yes (RX) Health Care FSA, HSA

Acupuncture/Acupressure Yes Health Care FSA, HSA

Adaptive Equipment Yes (LM) Health Care FSA, HSA

Adoption Fees No

Adoption, Pre-Adoption Medical Expenses Yes Health Care FSA, HSA

Adult Daycare Yes Dependent Care FSA

After-School Care or Extended Day Programs

(Supervised activities after school)Yes Dependent Care FSA

Agency Fee(Paid in order to receive dependent care)

Yes Dependent Care

Air Conditioner Yes (CG) Health Care FSA, HSA

Air Purifier Yes (CG) Health Care FSA, HSA

Airborne Yes (RX) Health Care FSA, HSA

Alcoholism Treatment Yes Health Care FSA, HSA

Allergy Medicines Yes (RX) Health Care FSA, HSA

Alli Yes (RX) Health Care FSA, HSA

Alternative Healers Yes (RX) Health Care FSA, HSA

Ambulance Yes Health Care FSA, HSA

Analgesics Yes (RX) Health Care FSA, HSA

Antacids / Acid Reducers Yes (RX) Health Care FSA, HSA

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Due to frequent updates to the regulations governing FSAs and HSAs, this list does not guarantee reimbursement, but instead is to

be utilized as a guide for the submission of claims.

The following is a summary of common expenses for Health Care Flexible Spending Accounts (FSAs), Dependent Care Flexible

Spending Accounts (FSAs) and Health Savings Accounts (HSAs). Some plans, such as Limited Scope FSAs, restrict the eligible

expenses, so please refer to your employer's Summary Plan Description (SPD) for your specific plan details.

This list is not intended to be exhaustive and should only be used as a general guide. Expenses contained in this list may be denied

if the supporting claims documentation is insufficient or shows that the expense was incurred for services not considered medically

necessary. Payment of claims will be based on all applicable regulations, the employer's plan design and information on the claim

form. All expenses must be substantiated by information from a third party.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

© Flexible Benefit Service Corporation 1

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Anti-Arthritics Yes (RX) Health Care FSA, HSA

Anti-Itch Creams Yes (RX) Health Care FSA, HSA

Anti-Snore guards Yes (RX) Health Care FSA, HSA

Antibiotic Ointments Yes (RX) Health Care FSA, HSA

Anti-Diarrheal Yes (RX) Health Care FSA, HSA

Antifungal Products Yes (RX) Health Care FSA, HSA

Antihistamines Yes (RX) Health Care FSA, HSA

Arch Supports Yes Health Care FSA, HSA

Arm Sling Yes Health Care FSA, HSA

Arthritis gloves Yes Health Care FSA, HSA

Artificial Limbs Yes Health Care FSA, HSA

Arts and Crafts Fee No

Aspirin Yes (RX) Health Care FSA, HSA

Artificial Reproductive Technologies Yes (LM) Health Care FSA, HSA

Assisted Living No

Asthma Treatments Yes Health Care FSA, HSA

Athletic Mouth Guards No

Au Pair Yes Dependent Care FSA

Automobile Modifications Yes (LM) Health Care FSA, HSA

Baby Formula(Difference in cost between the special formula and regular formula will qualify) Yes (LM) Health Care FSA, HSA

Baby Oil No

Baby Powder No

Babysitter (Inside or outside participant's household)

Yes Dependent Care FSA

Back-up or Emergency Care Yes Dependent Care FSA

Bactine Yes (RX) Health Care FSA, HSA

Bandages, elastic Yes Health Care FSA, HSA

Bandages, non-medicated Yes Health Care FSA, HSA

Bandages, medicated Yes (RX) Health Care FSA, HSA

Beds, Mattresses Yes (LM) Health Care FSA, HSA

Bedside Commodes Yes Health Care FSA, HSA

Before-School Care or Extended Day Programs(Supervised activities before school)

Yes Dependent Care FSA

© Flexible Benefit Service Corporation 2

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Biofreeze Yes (RX) Health Care FSA, HSA

Birth Control Pills Yes (RX) Health Care FSA, HSA

Birth Control Devices Yes (RX) Health Care FSA, HSA

Birthing Classes Yes Health Care FSA, HSA

Blood Storage Yes (LM) Health Care FSA, HSA

Blood-Pressure Monitoring Devices Yes Health Care FSA, HSA

Blood-Sugar Test Kits and Test Strips Yes Health Care FSA, HSA

Boarding School No

Body Scans Yes Health Care FSA, HSA

Breast Pumps and Supplies Yes Health Care FSA, HSA

Breast reconstruction Surgery (Following mastectomy)

Yes Health Care FSA, HSA

Breathe Rite Strips Yes (RX) Health Care FSA, HSA

Bug Spray No

Caffeine Pills No

Calamine Lotion Yes (RX) Health Care FSA, HSA

Callous Removers No Health Care FSA, HSA

Caltrate Yes (RX) Health Care FSA, HSA

Cane, Walking Yes Health Care FSA, HSA

Capital Expenses Yes (LM) Health Care FSA, HSA

Cardiac Therapy Yes Health Care FSA, HSA

Carpal Tunnel Wrist Supports Yes Health Care FSA, HSA

Cast Covers Yes Health Care FSA, HSA

Chairs, Ergonomic(Difference in cost between ergonomic chair and a regular chair would qualify)

Yes (LM) Health Care FSA, HSA

Chairs, Reclining(Difference in cost between specialized recliner and a regular recliner would qualify)

Yes (LM) Health Care FSA, HSA

Chauffeur No

Chelation Therapy Yes Health Care FSA, HSA

Childbirth Classes Yes Health Care FSA, HSA

Chiropractic Adjustments Yes Health Care FSA, HSA

Chondroitin Yes (RX) Health Care FSA, HSA

Cialis Yes (RX) Health Care FSA, HSA

Circumcision Yes Health Care FSA, HSA

Claritin (loratadine) Yes (RX) Health Care FSA, HSA

© Flexible Benefit Service Corporation 3

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Co-Payments Yes Health Care FSA, HSA

Cold Medicine Yes (RX) Health Care FSA, HSA

Cold Sore Medicine Yes (RX) Health Care FSA, HSA

Cold/Hot Packs Yes Health Care FSA, HSA

Companion Animals Yes (LM) Health Care FSA, HSA

Compression Stockings Yes (RX) Health Care FSA, HSA

Condoms Yes Health Care FSA, HSA

Contact Lenses Yes Health Care FSA, HSA

Contact Lens Solution Yes Health Care FSA, HSA

Controlled Substances (In violation of federal law)

No

Cord Blood Storage Yes (LM) Health Care FSA, HSA

Corneal Ring Segments Yes Health Care FSA, HSA

Cosmetic Procedures Yes (LM) Health Care FSA, HSA

Cosmetics No

Cotton Balls No

Cough Drops/Suppressants Yes (RX) Health Care FSA, HSA

Counseling Yes Health Care FSA, HSA

CPAP Machine and Headgear Yes Health Care FSA, HSA

Crowns, Dental Yes Health Care FSA, HSA

Crutches Yes Health Care FSA, HSA

Custodial Care No

Day Camp Yes Dependent Care FSA

Daycare (Children age 12 and under)

Yes Dependent Care FSA

Deductibles Yes Health Care FSA, HSA

Decongestants Yes (RX) Health Care FSA, HSA

Dental Care, cosmetic No

Dental Floss No

Dental Implants Yes Health Care FSA, HSA

Dental Sealants Yes Health Care FSA, HSA

Dental Treatment Yes Health Care FSA, HSA

Denture Brush No

Denture Cleaners Yes Health Care FSA, HSA

Dentures and Denture Adhesives Yes Health Care FSA, HSA

© Flexible Benefit Service Corporation 4

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Diabetic Socks (Difference in cost between special socks and regular socks will qualify)

Yes (RX) Health Care FSA, HSA

Diabetic Supplies Yes Health Care FSA, HSA

Diagnostic Items and Services Yes Health Care FSA, HSA

Diaper Rash Ointments and Creams Yes (RX) Health Care FSA, HSA

Diapers or Diaper Service Yes (LM) Health Care FSA, HSA

Diarrhea Medicine Yes (RX) Health Care FSA, HSA

Diet Foods No

Dietary Supplements Yes (RX) Health Care FSA, HSA

Disabled Dependent, Care of Yes Dependent Care FSA

Disabled Qualifying Child (Age 12 and under)

Yes Dependent Care FSA

Discount Programs No

Doula Yes Health Care FSA, HSA

Drug Addiction Treatment Yes Health Care FSA, HSA

Drug Overdose, treatment of Yes Health Care FSA, HSA

Drug Screening Yes Health Care FSA, HSA

Ear Piercing No

Ear Plugs Yes (RX) Health Care FSA, HSA

Ear Wax Removal Products Yes (RX) Health Care FSA, HSA

Eczema Lotions and Creams Yes (RX) Health Care FSA, HSA

Egg Donor Fees Yes (LM) Health Care FSA, HSA

Eggs and Embryos, storage fees Yes (LM) Health Care FSA, HSA

Elder Care Yes Dependent Care FSA

Electrolysis or Hair Removal No

Electrolyte Replacements Yes (RX) Health Care FSA, HSA

Elevator Yes (CG) Health Care FSA, HSA

Epsom Salt Yes (RX) Health Care FSA, HSA

Exercise Equipment Yes (LM) Health Care FSA, HSA

Exercise Programs Yes (LM) Health Care FSA, HSA

Expectorants Yes (RX) Health Care FSA, HSA

Extended Daycare Yes Dependent Care FSA

Eye Drops Yes (RX) Health Care FSA, HSA

Eye Examinations, Eyeglasses, Equipment, Materials, and RepairYes Health Care FSA, HSA

© Flexible Benefit Service Corporation 5

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Face Creams No

Face Lifts No

Feminine Hygiene Products No

Fever-Reducing Medications Yes (RX) Health Care FSA, HRA, HSA

Fiber Supplements Yes (RX) Health Care FSA, HRA, HSA

FICA and FUTA taxes of Day-Care Provider Yes Dependent Care FSA

Field Trips No

Finance Charges No

First Aid Cream Yes (RX) Health Care FSA, HSA

First Aid Kits Yes Health Care FSA, HSA

Fitness Programs Yes (LM) Health Care FSA, HSA

Flavoring for Medication Yes Health Care FSA, HSA

Fluoride Rise Yes (RX) Health Care FSA, HSA

Flu Shots Yes Health Care FSA, HSA

Food(Difference in cost between special food and regular food would qualify)

Yes (LM) Health Care FSA, HSA

Foreign Countries, Medical Care Received in Yes Health Care FSA, HSA

Funeral Expenses No

Gambling Problem Treatment Yes (LM) Health Care FSA, HSA

Gauze Pads Yes Health Care FSA, HSA

Genetic Testing Yes (LM) Health Care FSA, HSA

Glasses Yes Health Care FSA, HSA

Glucosamine Yes (RX) Health Care FSA, HSA

Glucose-monitoring equipment Yes Health Care FSA, HSA

Guide dog, other service animal Yes Health Care FSA, HSA

Hair Colorants No

Hair Removal and Transplants Yes (LM) Health Care FSA, HSA

Hand Lotion No

Hand Sanitizer Yes (RX) Health Care FSA, HSA

Headache Medications Yes (RX) Health Care FSA, HSA

Healing Ointments Yes (RX) Health Care FSA, HSA

Health Club Fees Yes (LM) Health Care FSA, HSA

Health Institute Fees Yes (LM) Health Care FSA, HSA

Health Screenings Yes Health Care FSA, HSA

© Flexible Benefit Service Corporation 6

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Hearing Aids Yes Health Care FSA, HSA

Heating Pad Yes Health Care FSA, HSA

Hemorrhoid Treatments Yes (RX) Health Care FSA, HSA

Herbs Yes (RX) Health Care FSA, HSA

Holistic or Natural Healers Yes(Rx) Health Care FSA, HSA

Home Diagnostic Kits / Tests Yes Health Care FSA, HSA

Home Improvements Yes (LM) Health Care FSA, HSA

Home Medical Equipment Yes (LM) Health Care FSA, HSA

Homeopathic Products Yes (RX) Health Care FSA, HSA

Hormone Replacement Therapy (HRT) Yes (RX) Health Care FSA, HSA

Hospital Services Yes Health Care FSA, HSA

Household Help No

Humidifier Yes (RX) Health Care FSA, HSA

Hydrotherapy Yes (LM) Health Care FSA, HSA

Hypnosis Yes (LM) Health Care FSA, HSA

Hysterectomy Yes Health Care FSA, HSA

Illegal Operations and Treatments No

Immunizations Yes Health Care FSA, HSA

Incontinence Supplies Yes Health Care FSA, HSA

Insect-Bite Creams and Ointments Yes (RX) Health Care FSA, HSA

Insulin Yes Health Care FSA, HSA

In-Vitro Fertilization Yes (LM) Health Care FSA, HSA

Kindergarten No

Kleenex No

Lab Fees Yes Health Care FSA, HSA

Lactation Consultant Yes (LM) Health Care FSA, HSA

Lactose Intolerance Supplies Yes(Rx) Health Care FSA, HSA

Lamaze Classes Yes Health Care FSA, HSA

Language Training(Child with dyslexia or an otherwise disabled child)

Yes (LM) Health Care FSA, HSA

Laser Eye Surgery; Lasik Yes Health Care FSA, HSA

Laser Hair Removal Yes (LM) Health Care FSA, HSA

Late Fees No

Late Payment Fees No

© Flexible Benefit Service Corporation 7

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Expense Eligible Account Late Pickup Fee No Latex Gloves Yes (LM) Health Care FSA, HSA Laxatives Yes (RX) Health Care FSA, HSA

Lead-Based Paint Removal(Surfaces must be in poor repair and within a child's reach)

Yes Health Care FSA, HSA

Learning Disabilities Yes (LM) Health Care FSA, HSA

Legal Fees (To authorize treatment for mental illness)

Yes (LM) Health Care FSA, HSA

Levitra Yes (RX) Health Care FSA, HSA

Lice Treatments Yes (RX) Health Care FSA, HSA

Lifeline Screenings Yes Health Care FSA, HSA

Lifetime Care No

Liquid adhesive(For small cuts)

Yes Health Care FSA, HSA

Lodging at a Hospital or Similar Institution Yes Health Care FSA, HSA

Lodging, other (Up to $50 per night)

Yes(LM) Health Care FSA, HSA

Long-term Care Expenses No

Looking for Work (Care that enables the employee and/or spouse to look for work)

Yes Dependent Care FSA

Lotions No

Lubricants Yes (Rx) Health Care FSA, HSA

Lumbar Support Chair Cushions Yes (RX) Health Care FSA, HSA

Makeup No

Marijuana or other Controlled Substances (In violation of federal law)

No

Massage Therapy Yes (LM) Health Care FSA, HSA

Mastectomy-Related Special Bras Yes Health Care FSA, HSA

Maternity Aids Yes Health Care FSA, HSA

Maternity Clothing No

Mattresses Yes (RX) Health Care FSA, HSA

Meals at a Hospital or Similar Institution(When included in the cost of inpatient care)

Yes Health Care FSA, HSA

Meals not at a Hospital or Similar Institution No

Meals of a Companion No

Mederma Yes (RX) Health Care FSA, HSA

© Flexible Benefit Service Corporation 8

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Medical Alert Bracelet or Necklace Yes Health Care FSA, HRA, HSA

Medical Information Plan(Plan that maintains electronic medical information)

Yes Health Care FSA, HRA, HSA

Medical Records Charges Yes Health Care FSA, HRA, HSA

Medical Services Yes Health Care FSA, HSA

Medical Supplies Yes Health Care FSA, HSA

Medicated Lip Products Yes (RX) Health Care FSA, HSA

Menstrual Relief Yes (RX) Health Care FSA, HSA

Mentally Handicapped Special Home Yes (LM) Dependent Care FSA

Midwives Yes Health Care FSA, HSA

Migraine Medications Yes (RX) Health Care FSA, HSA

Mileage Charged by Dependent Care Provider Yes Dependent Care FSA

Mileage to Bring the Dependent to Daycare No

Mileage Incurred Travelling for Medical Reasons Yes Health Care FSA, HSA

Mineral Supplements Yes (RX) Health Care FSA, HSA

Missed Appointment Fees No

Morning-After Contraceptive Pills Yes (RX) Health Care FSA, HSA

Motion Sickness Patches or Wristband Yes RX Health Care FSA, HSA

Motion Sickness Medications Yes (RX) Health Care FSA, HSA

Mouthwash No

Multivitamins Yes (RX) Health Care FSA, HSA

Nanny Yes Dependent Care FSA

Nasal strips or sprays Yes (RX) Health Care FSA, HSA

Naturopathic Care Yes (LM) Health Care FSA, HSA

Nebulizer Yes Health Care FSA, HSA

Needle Container Yes Health Care FSA, HSA

Neti pots Yes Health Care FSA, HSA

Newborn Nursing Services (Normal and healthy baby)

No

Nicotine gum or patches Yes (RX) Health Care FSA, HSA

Norplant Insertion or Removal Yes Health Care FSA, HSA

Nursing Care and Services (Private Duty Nursing)

Yes (LM) Health Care FSA, HSA

Nursing Home No

Nutritional supplements Yes (RX) Health Care FSA, HSA

© Flexible Benefit Service Corporation 9

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Nutritionist Yes (LM) Health Care FSA, HSA

Obstetrical Expenses Yes Health Care FSA, HSA

Occlusal guards Yes Health Care FSA, HSA

Occupational Therapy Yes Health Care FSA, HSA

Online or Telephone Consultation (Medical practitioner's fee)

Yes Health Care FSA, HSA

Operations Yes Health Care FSA, HSA

Optometrist Yes Health Care FSA, HSA

Oral Care Products(e.g. Anbesol, Orajel)

Yes (RX) Health Care FSA, HSA

Orthodontia Yes Health Care FSA, HSA

Orthopedic Shoes(Excess cost between orthopedic shoes and regular shoes will qualify)

Yes (RX) Health Care FSA, HSA

Orthotic Inserts(Custom -made and over-the-counter)

Yes Health Care FSA, HSA

Osteopath Fees Yes Health Care FSA, HSA

Over-the-Counter-Medications Yes (RX) Health Care FSA, HSA

Overnight Camp No

Ovulation Monitor Yes Health Care FSA, HSA

Oxygen and Equipment Yes Health Care FSA, HSA

Pain Relievers Yes (RX) Health Care FSA, HSA

Parking Fees and Tolls(Related to medical care received)

Yes Health Care FSA, HSA

Pedialyte Yes (RX) Health Care FSA, HSA

Pedometer No

Pediculicide(e.g. Nix, Rid)

Yes (RX) Health Care FSA, HSA

Penile Implants Yes (LM) Health Care FSA, HSA

Perfume No

Peroxide Yes (RX) Health Care FSA, HSA

Personal Grooming Items No

Personal Trainer Fees Yes (LM) Health Care FSA, HSA

Physical Exams Yes Health Care FSA, HSA

Physical therapy Yes Health Care FSA, HSA

Pillows; Lumbar Support Yes (LM) Health Care FSA, HSA

© Flexible Benefit Service Corporation 10

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Placement Fees (For finding a dependent care provider)

No

Pregnancy Aids Yes Health Care FSA, HSA

Pregnancy test Kits Yes Health Care FSA, HSA

Prenatal Vitamins Yes (RX) Health Care FSA, HSA

Prepaid Fees for Dependent Care(Cannot be reimbursed until care is provided)

Yes Dependent Care FSA

Preschool/Nursery school Yes Dependent Care FSA

Prescription Drug Discount Programs No

Prescription Drugs/Medicines Yes (RX) Health Care FSA, HSA

Prescription Drugs/Medicines (Obtained from other countries)

No

Preventive Care Screenings Yes Health Care FSA, HSA

Probiotics Yes (RX) Health Care FSA, HSA

Product Replacement Plans/Warranties No

Propecia Yes (LM) Health Care FSA, HSA

Prosthesis Yes Health Care FSA, HSA

Psychiatric Care Yes Health Care FSA, HSA

Psychoanalysis Yes (LM) Health Care FSA, HSA

Psychological Care Yes (LM) Health Care FSA, HSA

Q-tips No

Radon Mitigation Yes (LM) Health Care FSA, HSA

Reading Glasses Yes Health Care FSA, HSA

Recliner Chairs(Difference in cost between specialized recliner and a regular recliner would qualify)

Yes (LM) Health Care FSA, HSA

Reflexology Yes (LM) Health Care FSA, HSA

Registration Fee(Cannot be reimbursed until care is provided)

Yes Dependent Care FSA

Relative (Payments to a relative for dependent care)

Yes Dependent Care FSA

Retin-A Yes (LM) Health Care FSA, HSA

Rogaine Yes (LM) Health Care FSA, HSA

Rubbing alcohol Yes (RX) Health Care FSA, HSA

Safety Glasses Yes (RX) Health Care FSA, HSA

Schools and Education, Residential Yes (LM) Health Care FSA, HSA

© Flexible Benefit Service Corporation 11

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Schools and Education, Special Yes (LM) Health Care FSA, HSA

Screening Tests Yes Health Care FSA, HSA

Security System for the Home No

Seeing-Eye Dog/Other Service Animal Yes Health Care FSA, HSA

Self-Employment(Dependent care expense incurred in connection with)

Yes Dependent Care FSA

Shampoos No

Shaving cream or lotion No

Shipping and Handling Fees Yes Health Care FSA, HSA

Sick employee (Payments to dependent care provider when sick employee stays home)

Yes Dependent Care FSA

Sick-Child Facility Yes Dependent Care FSA

Sinus Medications Yes (RX) Health Care FSA, HSA

Sleep Aids Yes (RX) Health Care FSA, HSA

Smoking-Cessation Medications Yes (RX) Health Care FSA, HSA

Smoking-Cessation Programs Yes Health Care FSA, HSA

Soaps No

Special Foods(Difference in cost between special food and regular food would qualify)

Yes (RX) Health Care FSA, HSA

Speech Therapy Yes (LM) Health Care FSA, HSA

Sperm Storage Fees Yes (LM) Health Care FSA, HSA

Spermicidal Foam Yes (RX) Health Care FSA, HSA

Spouse of Employee (Payments to a spouse for dependent care)

No

Stem Cell Harvesting and/or Storage Yes (LM) Health Care FSA, HSA

Sterilization Procedures Yes Health Care FSA, HSA

Sterilization Reversal Yes Health Care FSA, HSA

St. Johns Wort Yes (RX) Health Care FSA, HSA

Student Health Fee No

Substance Abuse Yes Health Care FSA, HSA

Subway Fare (In connection with medical care received)

Yes Health Care FSA, HSA

Summer Day Camp Yes Dependent Care FSA

Summer School No

Sun Protective Clothing(Difference in cost between special clothing and regular clothing will qualify)

Yes (RX) Health Care FSA, HSA

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Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Sunburn Creams and Ointments Yes (RX) Health Care FSA, HSA

Sunglasses Yes (RX) Health Care FSA, HSA

Sunglasses, Clip-on Yes (RX) Health Care FSA, HSA

Sunscreen(Only SPF 30 and above will qualify)

Yes Health Care FSA, HSA

Sunscreen, Cosmetics/Similar Products with No

Supply Fees No

Support Hose/TED stockings Yes Health Care FSA, HSA

Surgery Yes Health Care FSA, HSA

Surrogate/Gestational Carrier Expenses No

Tanning Salon/Equipment Yes (LM) Health Care FSA, HSA

Taxes on Medical Services and Products Yes Health Care FSA, HSA

Taxi Fare(In connection to medical care received)

Yes Health Care FSA, HSA

Teeth Whitening No

Telephone for Hearing-Impaired Persons Yes Health Care FSA, HSA

Television for Hearing-Impaired Persons Yes Health Care FSA, HSA

Thermometers Yes Health Care FSA, HSA

Throat Lozenges Yes (RX) Health Care FSA, HSA

Toiletries No

Toll bridges(In connection with medical care received)

Yes Health Care FSA, HSA

Toothache/Teething Pain Relievers Yes (RX) Health Care FSA, HSA

Toothbrushes No

Toothpaste No

Transplants Yes Health Care FSA, HSA

Transportation Expenses(In connection with medical care received)

Yes Health Care FSA, HSA

Treadmill Yes (LM) Health Care FSA, HSA

Tuition Expenses No

Tuition for Special-Needs Program Yes (LM) Health Care FSA, HSA

Tutoring Programs No

UCR, Charges Above(If underlying expense is eligible)

Yes Health Care FSA, HSA

Ultrasound, Pre-Natal Yes Health Care FSA, HSA

© Flexible Benefit Service Corporation 13

Eligible ExpensesELIGIBLE CATEGORIES

Yes:  The expense is eligible for reimbursement. 

No:  The expense is not eligible for reimbursement under any circumstance.

Expense Eligible Account

Yes (LM):  The expense may be eligible for reimbursement if a Letter of Medical Necessity is provided to Flex.  The expense must be used to treat a

medical condition.

Yes (RX):  The expense is eligible for reimbursement if a doctor’s prescription has been obtained prior to purchase. A copy of the prescription will be

required for FSA reimbursement. Please ensure the prescription includes number of refills/expiration date.

Yes (CG): Some items that require a Letter of Medical Necessity may result in home improvement. This applies when a "capital gain" is made and

the account holder is subject to be reimbursed the difference.

Umbilical Cord Freezing/Storage Yes (LM) Health Care FSA, HSA

Unemployment (Dependent care that enables the employee and/or spouse to look for work)

Yes Dependent Care FSA

Vacation (Payments to dependent care provider for periods when employee is on vacation)

Yes Dependent Care FSA

Vaccines Yes Health Care FSA, HSA

Varicose Vein Treatment Yes (LM) Health Care FSA, HSA

Vasectomy Yes Health Care FSA, HSA

Vasectomy Reversal Yes Health Care FSA, HSA

Veneers No

Veterinary Services(For a guide dog or other service animal)

Yes Health Care FSA, HSA

Viagra Yes (RX) Health Care FSA, HSA

Vitamins Yes (RX) Health Care FSA, HSA

Volunteer Work (Dependent care that enables employee and/or spouse to volunteer)

No

Walkers Yes Health Care FSA, HSA

Warranties/Insurance on a Product No

Wart remover treatments Yes (RX) Health Care FSA, HSA

Water Fluoridation Yes (LM) Health Care FSA, HSA

Water Pik No

Weight Loss Drugs Yes (RX) Health Care FSA, HSA

Weight-Loss Programs Yes (LM) Health Care FSA, HSA

Weight-Loss Surgery Yes (LM) Health Care FSA, HSA

Wheelchair/Wheelchair Accessories Yes Health Care FSA, HSA

Whirlpool Bath Yes (LM) Health Care FSA, HSA

Wigs Yes (LM) Health Care FSA, HSA

X-Ray Fees Yes Health Care FSA, HSA

Yeast Infection Medications Yes (RX) Health Care FSA, HSA

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